What is bipolar disorder? Everything you need to know

What is bipolar disorder?

The term “bipolar” can be casually and carelessly tossed around as an insult or a joke. But for people living with bipolar disorder (BD), the condition is no laughing matter; BD needs to be taken seriously and often requires lifelong treatment.

Bipolar disorder is a mental health condition that causes mood swings and significant shifts in energy. Individuals diagnosed with the disorder can experience periods of extreme highs, called mania or manic episodes, and intense lows, referred to as depression or depressive episodes. These mood episodes can last for days or weeks.

More than 4% of adults in the U.S. experience BD at some point in their lives. Still, it’s unknown what specifically causes the mental disorder. The good news is that help is available to manage its symptoms.

Here’s everything you need to know about the different types of bipolar disorder, its potential causes, bipolar disorder symptoms and warning signs, and treatment options for this mental health condition.

Types of bipolar disorder

There are three diagnoses for bipolar disorder: bipolar I, bipolar II, and cyclothymic disorder. Here’s how each of the conditions is characterized.

Bipolar I

Bipolar I disorder is characterized by having at least one manic episode. People with bipolar I may also experience a depressive or hypomanic episode, as well as periods of neutral mood.

A manic episode lasts for at least one week, whereas a hypomanic episode lasts for only four consecutive days with less severe symptoms.

A major depressive episode will last at least two weeks and include several symptoms, such as intense sadness or despair and increased or decreased sleep. There is also the chance that a depressive episode will have mixed features, in which a person will experience both depressive and manic symptoms at the same time.

People living with bipolar I may also experience rapid cycling, or the occurrence of four or more episodes of mania or depression within one year.

Bipolar II

Bipolar II disorder is characterized by experiencing at least one major depressive episode and at least one hypomanic episode, but never any episodes of mania. Between these depressive and hypomanic episodes, people can function as they would if they weren’t experiencing a mood episode.

People living with bipolar II often deal with other mental conditions, such as anxiety disorders, ADHD, or substance use disorders.

Cyclothymic disorder

Cyclothymic disorder is characterized by experiencing frequent periods of hypomanic and depressive symptoms for at least two years. These symptoms, often called mood swings, are not severe enough to be categorized as episodes.

Other types of bipolar disorder

Suppose the symptoms and mood changes an individual is experiencing — such as clinically significant abnormal mood elevation — don’t match the criteria for bipolar I, bipolar II, or cyclothymic disorder. In that case, their condition is classified as “other specified” or “unspecified bipolar and related disorders.”

Causes of bipolar disorder

The exact cause of bipolar disorder is unknown. However, scientists have researched a number of different factors that may play a role in the development of BD, including neurological and genetic conditions, as well as life-related risk factors.

Brain structure and function

Neuroimaging is a process that uses various techniques to produce images of the brain. Researchers have used neuroimaging to study differences in the brain structure and function of people with the condition. They have not yet pinpointed specific biological differences that can cause BD. However, they have observed changes in the brain of those diagnosed with the disorder, such as size differences in certain brain structures.

Genetics

While symptoms of bipolar disorder can appear at any age, they more typically begin to show in late adolescence into a person’s early 20s. Those with a direct relative such as a parent or sibling with bipolar disorder may be more likely to develop the condition themselves. However, the role that genetics plays is still being researched.

Risk factors

Specific factors may trigger symptoms of bipolar disorder, such as “life-changing events, bullying, and even changes in the weather,” says Grow Therapy’s JohnNeiska Williams, a Licensed Professional Counselor (LPC) specializing in treating bipolar disorder. Here are some other risk factors that might trigger BD symptoms.

• Periods of high stress, such as the death of a loved one or the breakdown of a relationship

• Physical, sexual, or emotional abuse

• Physical illness

• Sleep disturbances

• Overwhelming problems in day-to-day life

According to Williams, if the symptoms triggered by any of these risk factors last longer than 24 months, or if periods of depressive symptoms or mania become more frequent and intense, reaching out to mental health providers for help may be necessary.

Signs and symptoms

Bipolar disorder is distinguished by the extreme mood swings it produces. Those dealing with BD generally experience intense highs and lows, along with the following symptoms and behavioral changes.

Mania and hypomania

A manic episode is described as a period of one week when an individual is extremely high-spirited or in an irritable mood for most of the days in that given week. They may also have more energy than usual and display some of the following behaviors:

• Decreased need for sleep

• Faster speech with quickly changing topics

• Uncontrollable racing thoughts

• Increased likelihood of being distracted

• Increased activity, such as restlessness or working on several projects at once

• Increased participation in risky behavior, such as dangerous driving and spending sprees

Manic symptoms tend to be more intense or aggressive than hypomanic symptoms, Williams says. For example, manic behaviors may include violence, drugs and alcohol use, sex, and paranoia. People with BD also can experience psychosis — defined as delusions or hallucinations — during their manic episodes.

In contrast, some hypomanic behaviors could include obsessions, impulsiveness, and excessive spending, she explains.

Major depressive episodes

A major depressive episode is a period of two weeks during which an individual displays at least five of the following symptoms of depression, including at least one of the first two symptoms:

• Intense sadness or despair

• Loss of interest in activities the person once enjoyed

• Feelings of worthlessness or guilt

• Fatigue

• Sleeping more or less than usual

• Eating more or less than usual

• Restlessness, slowed speech or movement

• Difficulty concentrating

• Frequent thoughts of death or suicide

Treatment options

If you think you or someone you know is showing signs of bipolar disorder, seeking an accurate diagnosis is essential to receive proper treatment.

There are several test instruments that can be used in the diagnosis of bipolar disorder, including the Mood Disorder Questionnaire, which Williams prefers.

“I also assess whether there have been long periods of depression and manic or hypomanic symptoms,” she says. “Most times, with the diagnosis of bipolar disorder, these symptoms have existed for more than two years.”

Once a diagnosis has been reached, there are effective treatment options available.

Therapy

Different types of psychotherapy, such as cognitive behavioral therapy (CBT) and family-focused therapy (FFT), have been shown to effectively treat and manage bipolar disorder and its symptoms when used in conjunction with medication.

CBT helps people with bipolar disorder recognize negative thoughts and teaches them coping strategies. FFT is a psycho-educational treatment that focuses on the alleviation of mood symptoms, relapse prevention, and enhancing psychosocial functioning. One of the main goals of FFT is to teach patients and their family members about the nature of bipolar disorder.

“Therapy is very important when working with BD,” Williams says. “Even when it becomes manageable, it’s important to have a ‘mental health check-up,’ where you assess whether the transitions between moods and episodes are still manageable on your own.”

Therapy can look different depending on the individual, the type of bipolar disorder, and the clinician’s approach.

“For example, when I work with clients that are diagnosed with bipolar II, I use prolonged exposure (PE) therapy or exposure therapy in general,” she says. “Therapy with me focuses a lot on awareness, relabeling, and reframing behaviors by re-exposing clients to the stress and learning to ground themselves in a counterintuitive way.”

Support groups may also be helpful for those that want to share their experiences with bipolar disorder and learn from others who are going through something similar.

Medication

Medication can be an important part of the treatment plan for bipolar disorder. Each person’s individual symptoms and medical history will dictate the specific type of medication that is prescribed. For example, mood stabilizers may be able to reduce the intensity of mood episodes. However, medication that helps with sleep or reduces anxiety and depression may also be necessary to address specific concerns.

It is especially important that individuals work with their health care provider to determine the specific medications that will best address their needs and to monitor the effects of those medications.

Electroconvulsive therapy

For individuals with severe symptoms of bipolar disorder that have not been effectively addressed through other treatments, electroconvulsive therapy (ECT) may be another treatment option. While the patient is under anesthesia, short, electrical pulses are used to stimulate the brain, resulting in a controlled seizure. ECT has also been shown to be effective in treating major depression.